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Deng H, Abouzeid CA, Shepler LJ, Ni P, Slavin MD, Barron DS, Herrera-Escobar JP, Kazis LE, Ryan CM, Schneider JC. Moderation Effects of Daily Behavior on Associations Between Symptoms and Social Participation Outcomes After Burn Injury: A 6-Month Digital Phenotyping Study. Arch Phys Med Rehabil 2024; 105:1700-1708. [PMID: 38754720 PMCID: PMC11374484 DOI: 10.1016/j.apmr.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To examine the moderation effects of daily behavior on the associations between symptoms and social participation outcomes after burn injury. DESIGN A 6-month prospective cohort study. SETTING Community. PARTICIPANTS Twenty-four adult burn survivors. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Symptoms and social participation outcomes were assessed weekly using smartphone surveys, including symptoms of pain (Patient-Reported Outcomes Measurement Information System [PROMIS] Pain Intensity and Pain Interference), anxiety (PROMIS Anxiety), and depression (Patient Health Questionnaire), as well as outcomes of social interactions and social activities (Life Impact Burn Recovery Evaluation [LIBRE] Social Interactions and Social Activities). Daily behaviors were automatically recorded by a smartphone application and smartphone logs, including physical activity (steps, travel miles, and activity minutes), sleep (sleep hours), and social contact (number of phone calls and message contacts). RESULTS Multilevel models controlling for demographic and burn injury variables examined the associations between symptoms and social participation outcomes and the moderation effects of daily behaviors. Lower (worse) LIBRE Social Interactions and LIBRE Social Activities scores were significantly associated with higher (worse) PROMIS Pain Intensity, PROMIS Pain Interference, PROMIS Anxiety, and Patient Health Questionnaire-8 scores (P<.05). Additionally, daily steps and activity minutes were associated with LIBRE Social Interactions and LIBRE Social Activities (P<.05), and significantly moderated the association between PROMIS Anxiety and LIBRE Social Activities (P<.001). CONCLUSIONS Social participation outcomes are associated with pain, anxiety, and depression symptoms after burn injury, and are buffered by daily physical activity. Future intervention studies should examine physical activity promotion to improve social recovery after burns.
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Affiliation(s)
- Huan Deng
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Cailin A Abouzeid
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA
| | - Mary D Slavin
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Boston University School of Public Health, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA
| | - Daniel S Barron
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Lewis E Kazis
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Boston University School of Public Health, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA
| | - Colleen M Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston®, Boston, MA, USA
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA; Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Deng H, Shepler LJ, Chacon KL, Tenney D, Ni P, Stewart BT, Carrougher GJ, Kowalske K, Wolf SE, Slavin MD, Kazis LE, Ryan CM, Schneider JC. Predictors at 6 and 12 Months for Social Participation Outcome at 24 Months in the Adult Burn Injury Population: A Burn Model System National Database Study. Arch Phys Med Rehabil 2024; 105:235-242. [PMID: 37392780 PMCID: PMC10756920 DOI: 10.1016/j.apmr.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To identify clinical factors (physical and psychological symptoms and post-traumatic growth) that predict social participation outcome at 24-month after burn injury. DESIGN A prospective cohort study based on Burn Model System National Database. SETTING Burn Model System centers. PARTICIPANTS 181 adult participants less than 2 years after burn injury (N=181). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographic and injury variables were collected at discharge. Predictor variables were assessed at 6 and 12 months: Post-Traumatic Growth Inventory Short Form (PTGI-SF), Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C), Patient-Reported Outcomes Measurement Information System (PROMIS-29) Depression, Anxiety, Sleep Disturbance, Fatigue, and Pain Interference short forms, and self-reported Heat Intolerance. Social participation was measured at 24 months using the Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities short forms. RESULTS Linear and multivariable regression models were used to examine predictor variables for social participation outcomes, controlling for demographic and injury variables. For LIBRE Social Interactions, significant predictors included the PCL-C total score at 6 months (β=-0.27, P<.001) and 12 months (β=-0.39, P<.001), and PROMIS-29 Pain Interference at 6 months (β=-0.20, P<.01). For LIBRE Social Activities, significant predictors consisted of the PROMIS-29 Depression at 6 months (β=-0.37, P<.001) and 12 months (β=-0.37, P<.001), PROMIS-29 Pain Interference at 6 months (β=-0.40, P<.001) and 12 months (β=-0.37, P<.001), and Heat Intolerance at 12 months (β=-4.55, P<.01). CONCLUSIONS Post-traumatic stress and pain predicted social interactions outcomes, while depression, pain and heat intolerance predicted social activities outcomes in people with burn injury.
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Affiliation(s)
- Huan Deng
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Kaitlyn L Chacon
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | | | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA
| | - Barclay T Stewart
- The University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA
| | | | - Karen Kowalske
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Mary D Slavin
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Boston University School of Public Health, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA
| | - Lewis E Kazis
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Boston University School of Public Health, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA
| | - Colleen M Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA; Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Rodríguez-Mercedes SL, Patel KF, Rencken CA, Grant GG, Surette K, Kinney EM, Brady KJ, Slavin MD, Schneider JC, Stoddard FJ, Kazis LE, Ryan CM. Item Pool Development for the School-Aged Life Impact Burn Recovery Evaluation Profile Computerized Adaptive Test: An Observer-Reported Outcome Assessment Measuring the Impact of Burn Injuries in School-Aged Children. J Burn Care Res 2022; 43:1114-1128. [PMID: 34965302 PMCID: PMC9255664 DOI: 10.1093/jbcr/irab247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The transition from early childhood to teen years (5-12) is a critical time of development, which can be made particularly challenging by a burn injury. Assessing postburn recovery during these years is important for improving pediatric survivors' development and health outcomes. Few validated burn-specific measures exist for this age group. The purpose of this study was to generate item pools that will be used to create a future computerized adaptive test (CAT) assessing postburn recovery in school-aged children. Item pool development was guided by the previously developed School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) conceptual framework. The item pool development process involved a systematic literature review, extraction of candidate items from existing legacy measures, iterative item review during expert consensus meetings, and parent cognitive interviews. The iterative item review with experts consisted of six rounds. A total of 10 parent cognitive interviews were conducted. The three broad themes of concern were items that needed 1) clarification, needed context, or were vague, 2) age dependence and relevance, and 3) word choice. The cognitive interviews indicated that survey instructions, recall period, item stem, and response choices were interpretable by respondents. Final item pool based on parental feedback consists of 57, 81, and 60 items in physical, psychological, and family and social functioning, respectively. Developed item pools (n = 198) in three domains are consistent with the existing conceptual framework. The next step involves field testing the item pool and calibration using item response theory to develop and validate the SA-LIBRE5-12 CAT Profile.
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Affiliation(s)
| | - Khushbu F. Patel
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Camerin A. Rencken
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Gabrielle G. Grant
- University of North Carolina at Chapel Hill, School of Nursing, Hillman Scholars in Nursing Innovation, Chapel Hill, NC
| | - Kate Surette
- Shriners Hospitals for Children – Boston, Boston, MA
| | | | - Keri J.S. Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Mary D. Slavin
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Jeffrey C. Schneider
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
| | - Frederick J. Stoddard
- Shriners Hospitals for Children – Boston, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
| | - Colleen M. Ryan
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
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Slavin MD, Ryan CM, Schneider JC, Acton A, Amaya F, Saret C, Ohrtman E, Wolfe A, Ni P, Kazis LE. Interpreting Life Impact Burn Recovery Evaluation Profile Scores for Use by Clinicians, Burn Survivors, and Researchers. J Burn Care Res 2021; 42:23-31. [PMID: 32556266 PMCID: PMC8265741 DOI: 10.1093/jbcr/iraa100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a patient-reported outcome measure developed to assess social participation in adult burn survivors. This study identified numeric score cut-points that define different levels of social participation ability and described each level. An expert panel identified numeric score cut-points that distinguish different levels of social participation for the six LIBRE Profile domains. Methods employed an iterative, modified-Delphi approach, and bookmarking to review calibrated item banks. Analyses (using calibration sample data and repeated in a validation sample) examined means, SDs, and sample distributions for each level. Analyses of variance examined score differences between levels. The panel developed descriptions for each established level. Initial cut-points resulted in four levels for five domains (Social Activities, Social Interactions, Romantic Relationships, Sexual Relationships, and Work & Employment) and five levels for the sixth domain (Relationships with Family & Friends). Comparisons demonstrated significant differences between level mean scores for all domains (P < .05) except Relationships with Family & Friends. Based on follow-up surveys, Relationships with Family & Friends score cut-points were adjusted to identify four levels with significant score differences between all levels. Panelists reached consensus for level descriptions. Score cut-points and descriptions identify different levels of social participation, providing a relevant context for interpreting LIBRE Profile numeric scores. LIBRE Profile Social Participation levels will help clinicians and persons with burn injury interpret LIBRE Profile numeric scores and promote use of this important new assessment.
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Affiliation(s)
- Mary D. Slavin
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, Massachusetts
| | - Colleen M. Ryan
- Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Hospitals for Children-Boston®
| | - Jeffrey C. Schneider
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Spaulding Research Institute, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, Michigan
| | - Flor Amaya
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, Massachusetts
| | - Cayla Saret
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, Massachusetts
| | - Emily Ohrtman
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Audrey Wolfe
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Pengsheng Ni
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, Massachusetts
| | - Lewis E. Kazis
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, Massachusetts
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Fassel M, Grieve B, Hosseini S, Oral R, Galet C, Ryan C, Kazis L, Pengsheng N, Wibbenmeyer LA. The Impact of Adverse Childhood Experiences on Burn Outcomes in Adult Burn Patients. J Burn Care Res 2020; 40:294-301. [PMID: 30873544 DOI: 10.1093/jbcr/irz014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Adverse childhood experiences (ACEs), including child maltreatment and household dysfunction, define adverse events that occur before 18 years of age. National and state data show that between 12.5 and 14.5% of the adult population report ≥4 ACEs (HIGH-ACE), respectively. HIGH-ACEs are associated with more chronic health problems. To date, the interaction between ACEs and burn injuries has not been studied. Herein, we sought to define the ACE exposure in our burn patients and its impact on early outcomes. Inpatient and outpatient adult burn survivors (≥18 years of age) were enrolled. Subjects completed surveys assessing adverse experiences (ACEs-18), needs, strengths, and resiliency at consent, and pain, depression, post-traumatic stress disorder (PTSD), and social participation surveys at 2 weeks to 3 months postinjury. Demographics, burn, and hospital course data were also collected. Chi-square and student's t-tests were used for descriptive analysis and to compare the groups (HIGH-ACE vs LOW-ACE). The HIGH-ACE group (n = 24; 45.3%) reported more depressive symptoms (P < .04) than the LOW-ACE group (n = 29, 54.7%). HIGH-ACE patients were less resilient when facing stressful events (P ≤ .02) and more likely to screen positive for probable PTSD (P = .01) and to score lower on the Life Impact Burn Recovery Evaluation Profile (LIBRE Profile), which assesses for social participation, in the domain of Family and Friends (P = .015). Our exploratory study suggests that ACE screening may help detect burn patients at risk for a more complicated recovery, thereby promoting personalized assistance in recovery.
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Affiliation(s)
- Mikenzy Fassel
- Carver College of Medicine, University of Iowa, Iowa City
| | - Brian Grieve
- Carver College of Medicine, University of Iowa, Iowa City
| | - Sameen Hosseini
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City
| | - Resmiye Oral
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City
| | - Colette Galet
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City
| | - Colleen Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School Shriners Hospitals for Children-Boston
| | - Lewis Kazis
- Center for the Assessment of Pharmaceutical Practices (CAPP), Department of Health Policy and Management, Boston University School of Public Health, Massachusetts
| | - Ni Pengsheng
- Center for the Assessment of Pharmaceutical Practices (CAPP), Department of Health Policy and Management, Boston University School of Public Health, Massachusetts
| | - Lucy A Wibbenmeyer
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City
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Saret CJ, Ni P, Marino M, Dore E, Ryan CM, Schneider JC, Kazis LE. Social Participation of Burn Survivors and the General Population in Work and Employment: A Life Impact Burn Recovery Evaluation (LIBRE) Profile Study. J Burn Care Res 2019; 40:669-677. [PMID: 31069384 DOI: 10.1093/jbcr/irz076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Work integration and retention after burn injury is a key outcome. Little is known about how burn survivors reintegrate into the workplace. This article compares scores on the Life Impact Burn Recovery Evaluation (LIBRE) Profile, a burn-specific measure of social participation, between burn survivors and general population samples, focusing on the Work and Employment domain. METHODS Convenience samples of burn survivors and the U.S. population were obtained. Differences in demographic and clinical characteristics and LIBRE Profile scores were assessed. To examine work and employment, we compared family and friends, social activities, and social interactions scores among working vs nonworking burn survivors. RESULTS Six hundred and one burn survivors (320 employed) and 2000 U.S. residents (1101 employed) were surveyed. The mean age (P = .06), distributions of sex (P = .35), and Hispanic ethnicity (P = .07) did not differ significantly. Distributions of race (P < .01) and education (P = .01) differed significantly. The burn survivor sample had higher scores, demonstrating higher participation, for work and employment (mean = 49.5, SD = 9.42) than the general sample (mean = 46.94, SD = 8.94; P < .0001), which persisted after adjusting for demographic characteristics. Scores on the three domains administered to all respondents were higher (P < .001) for working than nonworking burn survivors. CONCLUSION Distributions indicated higher social participation in the burn survivor sample than the general sample. Possible explanations include sample bias; resilience, posttraumatic growth, or response-shift of survivors; and limitations of using items in the general sample. Working burn survivors scored higher than those not working. Future work can explore factors that mediate higher scores and develop interventions.
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Affiliation(s)
- Cayla J Saret
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Pengsheng Ni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Molly Marino
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Emily Dore
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts.,Shriners Hospitals for Children-Boston®, Massachusetts
| | - Jeffrey C Schneider
- Harvard Medical School, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
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Cartwright S, Saret C, Shapiro GD, Ni P, Sheridan RL, Lee AF, Marino M, Acton A, Kazis LE, Schneider JC, Ryan CM. Burn survivors injured as children exhibit resilience in long-term community integration outcomes: A life impact burn recovery evaluation (LIBRE) study. Burns 2019; 45:1031-1040. [DOI: 10.1016/j.burns.2019.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/31/2019] [Accepted: 02/07/2019] [Indexed: 12/20/2022]
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Dore EC, Marino M, Ni P, Lomelin-Gascon J, Sonis L, Amaya F, Ryan CM, Schneider JC, Jette AM, Kazis LE. Reliability & validity of the LIBRE Profile. Burns 2018; 44:1750-1758. [PMID: 30075970 DOI: 10.1016/j.burns.2018.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/20/2018] [Accepted: 04/04/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Life Impact Burn Recovery Evaluation (LIBRE) Profile© was developed using Item Response Theory methods to assess social participation after a burn injury. The LIBRE Profile measures six areas of social participation: Relationships with Family & Friends, Social Interactions, Social Activities, Work & Employment, Romantic Relationships, and Sexual Relationships. It can be administered through a computerized adaptive test or through fixed short forms. The goal of this study was to further examine the psychometric properties of the LIBRE Profile, including reliability and validity. METHODS We examined the validity of the LIBRE Profile by administering the six LIBRE Profile scales as well as legacy measures that assessed similar constructs. We calculated the Pearson correlations between the LIBRE Profile scales and the scores on the same-domain and cross-domain legacy measures to evaluate convergent and divergent validity. We then administered the LIBRE Profile scales a second time, seven to ten days after the first administration, to a sample of adult burn survivors to evaluate test-retest reliability. We calculated repeatability coefficients, standard error of measurement, and minimal detectable change to establish the threshold beyond which the amount of change observed across an episode of care cannot be explained as measurement error. RESULTS For reliability, the repeatability coefficients ranged from 7.31 to 9.27 and SEMs ranged from 2.62 to 3.39 for all six scales. MDC90 values ranged from 6.08 to 7.86 points, and MDC95 values ranged from 7.26 to 9.40 points. All correlations between the LIBRE Profile scales and legacy measures are significant (p<0.05) and in the expected directions for both convergent and divergent validity. CONCLUSIONS This study provided evidence for the reliability and validity of the LIBRE Profile, one of the first tools that measures exclusively the social participation after a burn injury.
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Affiliation(s)
- Emily C Dore
- Boston University School of Public Health, Department of Health Law, Policy, and Management, United States
| | - Molly Marino
- Boston University School of Public Health, Department of Health Law, Policy, and Management, United States
| | - Pengsheng Ni
- Boston University School of Public Health, Department of Health Law, Policy, and Management, United States
| | - Julieta Lomelin-Gascon
- Boston University School of Public Health, Department of Health Law, Policy, and Management, United States
| | - Lily Sonis
- Boston University School of Public Health, Department of Health Law, Policy, and Management, United States
| | - Flor Amaya
- Boston University School of Public Health, Department of Health Law, Policy, and Management, United States
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Shriners Hospitals for Children - Boston(®), Boston, MA, United States
| | - Jeffrey C Schneider
- Harvard Medical School, Boston, MA, United States; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Alan M Jette
- MGH Institute of Health Professions, United States
| | - Lewis E Kazis
- Boston University School of Public Health, Department of Health Law, Policy, and Management, United States.
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